Position Description

There comes a point when you’re ready to take off the training wheels and start guiding others. If that’s where you are today, let’s talk about where you can be tomorrow with our leading, global health care organization. UnitedHealth Group is driving ever higher levels of sophistication in how provider networks are composed and compensated. Everything is open to new ideas and innovation. Here’s where you come in. Your expertise in provider networks can help us build in the next phase of evolution. In this role, you’ll use your knowledge and analytical skills to help determine how clinical providers group up by specialty and service line. As you do, you’ll discover the resources, backing and opportunities that you’d expect from a Fortune 6 leader.

If you are located in the Cleveland, OH area, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

Functioning independently, travel across assigned territory to meet with providers to discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage Members

Will be out in the field 80% of time in defined territory with rare occasion of overnight travel

Utilizing data analysis, identify and target providers who would benefit from our coding, documentation and quality training and resources

Manage end-to-end Risk and Quality Client Programs such as Healthcare Patient Assessment Form on ensuring correct delivery of data/forms to the correct providers, and the return of the data to coding ops, ensuring accurate payments are occurring for each provider based on client contract

Consult with provider groups on gaps in documentation and coding

Provide feedback on EMR/EHR systems where it is causing issues in meeting CMS standards of documentation and coding

Partner with a multi-disciplinary team to implement prospective programs as directed by Market Consultation leadership

Assists providers in understanding the Medicare quality program as well as CMS-HCC Risk Adjustment program as it relates to payment methodology and the importance of proper chart documentation of procedures and diagnosis coding

Supports the providers by ensuring documentation supports the submission of relevant ICD -10 codes and CPT2 procedural information in accordance with national coding guidelines and appropriate reimbursement requirements

Must be able to work effectively with common office software, coding software, EMR and abstracting systems

Ability to travel up to 75% regionally

Preferred Qualifications:

Previous experience in Risk Adjustment or HEDIS / Stars

Nursing background, i.e. LPN, RN, NP

Knowledge of EMR for recording patient visits

Previous experience in management position in a physician practice

Master's degree

1+ year(s) of coding performed at a health care facility

Knowledge of billing / claims submission and other related actions

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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